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Online Application

APPLICATION INSTRUCTIONS

Please read these instructions carefully. If you have any questions, please call (831) 392-5283 or email The Living Breath Foundation at LivingBreathFoundation@gmail.com

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Complete this entire application form and upload all the requested additional information. If there are items that are not relevant to you, please write N/A.

Documents you will need

To complete the application process you will need to provide the following documents:

  • A letter from your doctor confirming you have Cystic Fibrosis

  • Your most current tax return or your most current payroll stub.  If you are not working, please provide your SSI, SSDI, or Social Security proof of income.

  • Supporting Documents.  Some examples would be:  a copy of hotel expenses incurred while the child or spouse is in the hospital, a copy of un-reimbursed medical equipment, a copy of unpaid bills from the hospital*, doctors, or pharmacy

* Please Note: if you are applying for help with a hospital bill, you must first apply for aid directly from the hospital and then provide us with their denial letter.

Future Phone Interview

After receiving your application, a representative from the Foundation will contact you to schedule a phone interview. This interview helps us gain a better understanding of your needs and how we can help.

FINANCIAL ASSISTANCE ONLINE APPLICATION

Section 1 of 4 - Personal Information

Personal Information of the Individual with CF

Is the individual with CF a child or an adult?
Child
Adult
Pronouns
Date of Birth
Is the Individual with CF a US Citizen?
Yes
No
Have you applied for a LBF grant before?
Yes
No
Not Sure

Section 2 of 4 - Personal Statement

Please provide a one to two-paragraph statement describing why you need financial assistance and how The Living Breath Foundation could help you.


Our board of directors will review your personal statement.


We will not accept your application without a personal statement.

Section 3 of 4 - Upload Documents

1. Upload Doctor's Confirmation Letter

Please provide a letter from your doctor confirming you or your child have CF.

2. Upload Tax Return or Payroll Stub

Please provide either:

  • Your most current tax return (just the first 1-2 pages that show your income, we don't need the full tax return)

  • Your most current payroll stub

3. Supporting Documents, Bills or Medical Statements

Please send a copy of ONLY the item(s) you need help with.


These are some examples:

  • A copy of unpaid bills from the *hospital, doctors, or pharmacy.

  • A copy of hotel expenses incurred while the child or spouse is in the hospital.

  • A copy of un-reimbursed medical equipment.


*Note that if you are applying for help with a hospital bill, you must first apply for aid directly from the hospital and then provide us with their denial letter.

Section 4 of 4 - Signatures

Consent to review financial information

I give permission to the Living Breath Foundation’s board members to view the information on this form and the information submitted with this application.

Application Certification

I certify that the information presented in my application is accurate and complete. I understand and agree that any inaccurate information, misleading information, or omission will be cause for the invalidation of any grant offered to me. The Living Breath Foundation may verify all parts of my application materials. If they award me a grant, I give my permission to publicize my name. I also understand that I must provide my social security number to the Living Breath Foundation to qualify for a grant.

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